(via) Volunteering and Partnerships
1.0
Introduction
The essence of the
Immunization System is for “effective and efficient service delivery of pre and
post vaccination activities leading to immunization and thereby reducing the
risks of mortality, morbidity and disability from vaccine preventable diseases
in humans.
1.1 The Obvious Situation
Immunization is
one of the world’s most cost-effective health interventions. However, each year
approximately 25 million infants are not fully vaccinated (unimmunized and
drop-outs), and at least 2.4 million children die from vaccine-preventable
diseases.
1.2 The Nigeria’s Efforts
Nigeria’s Expanded
Programme on Immunization (EPI) was first initiated in 1979 (37 Years) and the
Federal Government of Nigeria through the Federal Ministry of Health continues
to place high priority on immunization. In 1999 (17 years ago), a new drive to
sustainably re-vitalize the immunization system commenced in synergy with the
accelerated strategy on polio eradication. Consequently, the Federal Government
established the National Programme on Immunization (NPI) (20 years later) whose
key focus was to provide support to the implementation of state and LGA
immunization programmes.
1.3 The Partners (WHO and others)
WHO provides
technical support to national authorities at federal, state, local government
and ward levels to strengthen the implementation of the Reaching Every Ward
(REW) strategy and the Government of Nigeria signed a memorandum of
understanding (MoU) with WHO to conduct training on the strategy for health
workers at national, state, local government and ward levels.
1.4 Outcomes
The support
provided by WHO, along with other partners, to the efforts of national
authorities in routine immunization (RI) has contributed to improved access to
and coverage of routine immunization services. Part of the evident outcomes is
that the number of fixed immunization service delivery points and outreach
immunization sites continues to increase steadily.
1.5 Imparts
Supported by
immunization partners Nigeria has made great strides in the past years, in
particular in its polio eradication efforts. This gave hopes that the year 2010
could have seen the interruption of transmission. But unfortunately, Nigeria
still battles polio endemicity till date having been delisted in September 2015
and relisted in September 2016 – a situation that emanated from the communities
suffering insurgency – Borno State.
1.6 The New Challenge – The Unfinished Business
The discovery of
four (4) confirmed WPV type 1 in Jere (1
on July 4), Gwoza (1 on July 13)
and Mongonu (2 on August 6 & 21)
LGAs of Borno state, NorthEast Nigeria has seen our country relisted to the polio
endemic countries (with Pakistan – 8 and
Afghanistan – 3), thereby denying the AFRO region the expected polio free
certification (formerly scheduled for
2017). This is so sad and implies a lot more in terms of reputation (for
Nigeria) and resource (for WHO and partners).
With these developments, there have risen great needs
to combat this situation with more than the required seriousness as this season
(Quarter 4) is a terrible one in this matter – we are in a season when most
people travel to the various parts of the country and we cannot afford a wider
spread of this WPV-1 in the country, due to the bigger implications in view, if
that happens.
1.7 Pre – Recommendations
Therefore, I would
recommend that WHO and partners take a more drastic and effective measures, (some of which I would recommend in 3.0
of this article) to see that the affected areas are well covered and the
required prevention programs effectively implemented with all aggressiveness.
It is not time to ask whose it is, but it is time to ask what best can be done
(what best-practices can be employed).
2.0 Responsibilities
Looking at the
Immunization Systems in Nigeria from a “practical perspective”, I have
personally observed the SWOT and by this article hope to reach the relevant
parties to see how these ideas can help boost the immunization systems while
maintaining cost-effectiveness. Who are
responsible in Immunization Systems?
2.1 The National Government
The national
government creates the Immunization Systems (EPI, 1979). It is also the role of
the government to monitor and drive the effectiveness and efficiency of the
system (NPI, 1999) to ensure the protection of her citizens and proper
utilization of their resources and that of her partners.
2.2 The Partners (WHO and others)
The partners
support the Immunization Systems created by the national governments. Partners
contribute to the funding, monitoring, surveillance, human resource
development, supply of quality vaccines and advocacy for effective Immunization
Activities – to both the government and also the People.
2.3 The Health Workers
The health workers
are key players in the Immunization system as they sit at the pivot point and
cannot be done without, if the system must function effectively and deliver its
expected outcomes, outputs and imparts. The HW is the interface between the Government,
Partners and the People (Communities). They manage and utilize resources, while
delivering services to the people and sending reports back to the upper levels
of government and partners – a reason that has made each HW in Immunization the
god of the system/process. I used the word “god” because, only the HW knows
exactly what happens to both vaccines and the people and returns reports to the
upper levels with which major future decision are taken.
Note: They are too important and strongly positioned
in the immunization system, such that if they choose to sabotage the system, it
may not be very easy to discover early and stop them, until proper DQS, DQA,
etc are carried out, which will cost more resources. Why don’t we strengthen the HWs’
roles via voluntarism?
2.4 The Community/Society Leaders
The Leaders of the
community have the responsibility to improve social mobilization of their
subjects towards serious involvement in immunization activities through well
planned local sensitizations/publicities using their locally valued programs –
daily, weekly, monthly, annual customary events, in their local languages and
dialects to bring home the message of the need for immunization.
2.5 The Parents and Guardians
The parents and
guardians are very important and powerful in this system to an extent that even
the health laws have found it so sentimental to handle them (esp. in Africa,
Nigeria inclusive). They decide whether or not their children and wards should
receive immunization through vaccination activities. The men especially have so
much power that they can even hinder their pregnant women from receiving
necessary vaccinations (i.e. TT1,2,3,4,5, etc), as is rampant in the north.
Note: most times, the parents and guardians have
violated the right of their children and wards to receive good health services
provided by their government. This should be looked at from the legal
perceptive urgently. Meanwhile, the Health Workers and Community Leaders are should
work harder to win these ones over.
2.6 The Citizens (Children, pregnant women and others)
The recipients of
beneficiaries of the immunization system are mostly the children and women. The
children have automatic obligations to receive vaccinations as required, which
is always dependent on their parents and guardians to take them to the health
centres and/or accept/receive immunization workers to administer services to
them. The women have obligations to understand, accept and involve themselves
in the immunization activities.
2.7 The Society/Community Development Advocates
The Community
Based Organizations (i.e. Age Grade, Women/Men/Youth Associations, etc),
Non-Governmental Organizations, Non-Profits, Corporate Social Responsibility
departments of companies (esp. Telecomm industry) operating in and making
profit from our local communities and people (MTN, Dangote Group, Airtel,
Uni-Lever, Globacom, Nokia, Etisalat etc), Academic Institutions, etc should
get involved more than ever before in the immunization campaigns in the local communities
where they operate and use every business opportunity to advertise the
importance of proper vaccination and immunization.
Note: The government and partners should allow
more CBOs, NGOs, NPOs and other Local Youth groups to get involved in the
immunization system processes via voluntarism and partnership. I am certain a
lot of these groups desire to join.
3.0
Real Voluntarism and Para-professionalism – A Way out for Nigeria
One of the biggest
challenges of the Nigeria’s society and economy is the lack of ideas and will
to create solutions by studying youths. Millions of Students occupying all our
secondary and tertiary institutions across the nation can be very useful to
both themselves and our nation through voluntarism. Para-professionalism is an
acceptable scheme that allows students to trade their spare time and comfort in
exchange for practical knowledge and experience, while building a network of
professional connections with colleagues from other schools, senior
professional colleagues and organizations that would help them in the future
at/after graduation. This is very needful at this point in the development
strategies of nation – Nigeria.
Note: This does not replace NYSC, but can phase
out the ineffective SIWES in our tertiary school curricular, while introducing
mentorship to the secondary level (contact me for a proposal or to speak more
about this on +2348063061305, n.chinomsosunday@gmail.com). This is my
calling and passion for life (Team).
3.1 Voluntarism and the Health Students
The introduction
and acceptance of real voluntarism and para-professionalism of health students
(Public Health, Nursing, Medicine, Pharmacy, students etc) is a real, more
effective and speedy means to both strengthen the Health systems and reduce the powers and semi-independence of
the local health workers in our local communities and health facilities.
When these HWs have young practice-hungry students deployed to their duty
stations from time to time, it places caution on manipulators as the students
play the roles of both challenging the HWs to do better, as well as setting
precedence on data reporting expectations for the government and partners,
thereby having check and balances in the system.
This scheme would
improve the knowledge of students in the health systems where they have chosen
to function in the future as professionals as well as naturally expunge the
misfits from the health vocation and place them in a career where they find
more practical fulfilment.
3.2 The Roles of National Government
The government
should task the Academic Institutions to create a quarterly or bi-annual
Students’ Voluntarism Scheme - SVS (Para-professionalism), through her
Education ministry, which should work like SIWES (improved), but must be
adequately implemented and monitored by both the Government, Academic
Institutions and Health Partners for effectiveness.
3.3 The Roles of the Academic Institutions
The academic
institutions should accept the need and then comply with the government in this
direction to create the SVS. Also the institutions should be able to monitor
feedbacks from the organizations where the students have been posted for SVS
activities from contact to acceptance to arrival to commencement to duties to
appraisal to conclusion to departure through a well-designed tracking system.
Note: For the purpose of reducing work load and
improving effectiveness, the senior students can be used in the monitoring as a
part of leadership training activities and also, a user-friendly mobile
application (with Geo-Coordinate capture field) should be used.
3.4 The Roles of the Students
For the students
themselves, this scheme would launch them into a world of practical
experiences, where they would be free to apply their school knowledge and
improve vocational understanding through practical works. They are the number
one beneficiaries of this system and their efficiency would positively impact
on the society and economy’s development rate. The students should take this
scheme very seriously and return the honest valuable feedbacks to the
implementing organs and authorized partners as and at when due for monitoring.
3.5 The Roles of Partners
Government
partners in health and education programs should get involved to make this
system work more effectively through Advocacy visits, Public Lectures in the
Academic Institutions, Human Capacity Development for the Students, Creation of
Software applications for effective feedback and monitoring among other
efforts. A typical health student would be very happy and feel important to be
associated with WHO and other partners, while also having expectations of
future opportunities with the organizations, thereby working hard in experience
to meet up with the practical and experiential requirements of the same
organizations.
4.0 Conclusion
I wish to conclude
with the current polio eradication status in Nigeria in mind, looking at Borno
state with great attention and seeking immediate feasible solutions to the
problem of the spread WPV-1 in the state and nation.
I would employ my
earlier recommendations for this purpose – use of Students, Youths in organized
CBOs, NGOs and other groups to reach out to the unreachable places where they
have a sort of influence. We would need to gather and enlighten a few learned
ones among them and use them for advocacy to their brothers and sisters to get
involved in the process of safe-guarding the health of their people. When we
succeed in building up the capacities of this squad, it would reduce the risk
of sending foreign bodies into the risky places, but using people that knows
the grounds and monitoring their activities through special M&E strategies
and location definition software applications by a dedicated Data Management
and M&E team. For now, we have to look inwardly, to identify who can be
used and the strategies that can be employed for effective delivery.
Note: It is my passion to get involved in the team
for strategies, re-orientation, training and designing and management of
monitoring & evaluation principles, plans and systems for effective
development in EPI/EIP in Nigeria and beyond.
I am already setting up teams across the country
(Nigeria) and other Africa countries (presently in Ghana, Cameroun, Kenya,
South Africa, Djibouti, Burundi, Equatorial Guinea, Tanzania, Uganda, Botswana,
Niger, Sierra Leone and reaching out for more) with my partners at New African
Chapter (NAC) – www.newafricanchapter.org.
Thank You very
much for your time.
Chinomso Sunday Nwosu
(Data Manager, WHO Abia – Volunteer)
